Healthcare Provider Details

I. General information

NPI: 1427558303
Provider Name (Legal Business Name): SCOTT A FLYNN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2018
Last Update Date: 02/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7330 SAN PEDRO AVE
SAN ANTONIO TX
78216-6235
US

IV. Provider business mailing address

1277 COUNTRY LN
MARION TX
78124-2034
US

V. Phone/Fax

Practice location:
  • Phone: 210-737-8090
  • Fax:
Mailing address:
  • Phone: 210-421-9958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number146801
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: